Provider Demographics
NPI:1700065802
Name:LOZOVOY, RUSLAN Y (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:RUSLAN
Middle Name:Y
Last Name:LOZOVOY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517A COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-4212
Mailing Address - Country:US
Mailing Address - Phone:313-585-3906
Mailing Address - Fax:
Practice Address - Street 1:900 N HERITAGE DR
Practice Address - Street 2:BUILDING A
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5536
Practice Address - Country:US
Practice Address - Phone:313-585-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17778363LF0000X
CO167214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily